A study of the mediating effect of online social support on the relationship between digital health literacy and frailty in older inpatients with chronic diseases

OBJECTIVE: To investigate the mediating effect of online social support on the relationship between digital health literacy and frailty in older inpatients with chronic diseases and provide a theoretical basis for clinical interventions. METHODS: Convenience sampling was used to select older inpatients with chronic diseases at a tertiary grade A hospital in Kunming from August 1 to December 31, 2025. A cross-sectional survey was conducted using a general information questionnaire, the Frail frailty assessment scale (FS), the Digital Health Literacy Scale (DHLS), and the Network Social Support Scale (NSSS). Univariate analysis, Pearson correlation analysis, and multiple linear regression were used to identify factors influencing frailty, and the Process macro (model 4) and Bootstrap method were used to test the mediating effect of online social support. RESULTS: A total of 504 older inpatients with chronic diseases were included. Their prefrailty rate was 42%, and their frailty rate was 53%. Their frailty score was (2.55±1.22) points, digital health literacy score was (41.48±14.83) points, and online social support score was (60.51±22.46) points. Correlation analysis showed that frailty was negatively correlated with digital health literacy and online social support (r=-0.753, -0.671, both P<0.001). Patients' age, educational level, number of chronic diseases, digital health literacy, and online social support influenced their frailty status (P<0.001). Online social support partially mediated the relationship between digital health literacy and frailty, with the mediating effect accounting for 45.2% of the total effect. CONCLUSIONS: The rates of prefrailty and frailty among older inpatients with chronic diseases are relatively high, and levels of both digital health literacy and online social support need improvement. Digital health literacy can not only directly negatively influence frailty but also exert an indirect effect through the mediating role of online social support. Clinical nursing care should focus on improving patients' digital health literacy and actively establishing and strengthening online social support systems so that the two work synergistically to improve patients' frailty status.